Senate Republicans are trying to revive the momentum to overhaul the Affordable Care Act with the Cassidy-Graham proposal. Here are five things to know about the plan and the rush to pass it. (Jenny Starrs/The Washington Post)

The Congressional Budget Office is a nonpartisan group tasked with evaluating the budgetary effects of legislation that’s proposed in the House and Senate. Its work has been contentious this year, because its analyses of the effects of the Republican efforts to overhaul or repeal Obamacare have been unwavering in their assessments: money saved, but millions more people lacking health coverage.

Those assessments didn’t do the GOP much good in building public support for the bills. Polling consistently showed that the pieces of legislation were widely unpopular, a function in part of those sharp coverage cuts. But Republican senators have a problem: In order to pass an overhaul under the rules of reconciliation — which, advantageously, requires only 50 votes to pass — they need to show that the legislation would offer budgetary savings. So what Republican Senate leaders would prefer is an analysis that shows their overhaul of Obamacare would cut costs but not an analysis that shows what the effects of those cuts would be.


Sen. Bill Cassidy (R-La.) speaks at a news conference on the Graham-Cassidy proposal on Capitol Hill on Sept. 13. (Yuri Gripas/Reuters)

On Monday, the CBO announced that this is what they would get. With a deadline of Sept. 30 looming for use of the reconciliation rules to pass a bill, the Congressional Budget Office announced that it would rush analysis of the current overhaul bill, called Graham-Cassidy after its two primary sponsors, by the beginning of next week. That analysis would include an assessment of whether the bill would increase deficits over the long term, which is necessary for reconciliation. But it wouldn’t go much further.

“CBO will provide as much qualitative information as possible about the effects of the legislation,” its announcement read, “however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.”

That’s very unusual. Below, a look at when and how the CBO has weighed in before other major health-care votes.


In 2009 and 2010, the CBO offered assessments of the likely effects of two pieces of legislation: The Senate bill that eventually became the Affordable Care Act, or Obamacare, and a House bill that was passed first. In each case, the CBO completed an analysis of the legislation before passage. In two cases, the analysis was released the day before the vote — but still before the vote.

This year, the process has looked different. There were two analyses completed in March, before the planned vote for the American Health Care Act that month. When that vote was pulled, those analyses were used to justify a heavily amended bill that was voted on and passed in May. The full CBO score for the amended bill wasn’t released until 20 days later.

The Senate’s efforts to pass legislation to complement the House bill, the Better Care Reconciliation Act, included a CBO score and an update to that analysis. The CBO also scored the Obamacare Repeal Reconciliation Act, a more explicit repeal that was considered by the Senate. Neither of those bills ended up passing.

That brings us to Graham-Cassidy. Less than a week before a vote needs to be taken — though perhaps not even that long before — the CBO will release incomplete data about the budgetary effects of the bill, and not much else.

It’s generally noted that this is not just any legislation, either. The health-care industry makes up about a sixth of the American economy, and this legislation would substantially reshape what that looks like. It just wouldn’t be clear exactly how until after it is passed.

If you’re hoping that perhaps some robust debate can help shed light on the legislation, some additional bad news.

Why? The allotted amount of time for debate has already been mostly used in debating previous iterations of the reconciliation bill.

Ninety seconds to debate overhauling a sixth of the economy is also pretty unusual.